Military psychologists and cultural competence: exploring implications for the manifestation and treatment of psychological trauma in the British armed forces.

This paper considers the manifestation and treatment of psychological trauma in the military. The article describes how military psychologists conceptualise psychological trauma within the culture of the Armed Forces (AF), which is reflected in the process of acquiring what has been referred to as cultural competency. Psychologists in this context acquire an understanding of the manner in which the psychological and organisational systems and culture of the military affect the presentation of psychological trauma, including post-traumatic stress disorder (PTSD). The paper outlines core psychological features of military life, including some of the ways in which the AF functions effectively as an adaptable fighting force. This highlights, for example, the potential for stigma within and between military personnel who experience mental health difficulties. The article proceeds to examine aspects of help-seeking in military mental healthcare, how symptoms can present at different stages in a deployment process, and the consequences that such problems can cause for military conduct and performance. Psychological care in the military is structured within an occupational mental health ethos, in which psychologists fulfil a range of clinical, organisational and leadership roles. These dynamics are explored with examples of care pathways and clarity on evidence-based interventions for trauma and PTSD in those experiencing military-related psychological injuries. Two vignettes are then offered to illustrate how some of these interventions can be used psychotherapeutically in addressing symptoms pertaining to hyperarousal, hypervigilance, guilt and shame.

[Modern state and prospects of development of medical-and-psychological support of military servicemen of the Armed Forces of the Russian Federation].

The authors analysed state and prospects of medical-and-psychological support of military servicemen, which is supposed to consider as a complex of measures aimed at monitoring of professional psychological health, professional-and-psychological expertise, psychophysiological and pharmacological, correction, and medical-and-psychological rehabilitation. Organisation and maintaince of the above mentioned measures should be carried out by specialists of medical--and-psychological support groups and medical-and-psychological correction.

Use of evidence-based treatment for posttraumatic stress disorder in Army behavioral healthcare.

OBJECTIVE: To identify the extent to which evidence-based psychotherapy (EBP) and psychopharmacologic treatments for posttraumatic stress disorder (PTSD) are provided to U.S. service members in routine practice, and the degree to which they are consistent with evidence-based treatment guidelines. METHOD: We surveyed the majority of Army behavioral health providers (n = 2,310); surveys were obtained from 543 (26%). These clinicians reported clinical data on a total sample of 399 service member patients. Of these patients, 110 (28%) had a reported PTSD diagnosis. Data were weighted to account for sampling design and nonresponses. RESULTS: Army providers reported 86% of patients with PTSD received evidence-based psychotherapy (EBP) for PTSD. As formal training hours in EBPs increased, reported use of EBPs significantly increased. Although EBPs for PTSD were reported to be widely used, clinicians who deliver EBP frequently reported not adhering to all core procedures recommended in treatment manuals; less than half reported using all the manualized core EBP techniques. CONCLUSIONS: Further research is necessary to understand why clinicians modify EBP treatments, and what impact this has on treatment outcomes. More data regarding the implications for treatment effectiveness and the role of clinical context, patient preferences, and clinical decision-making in adapting EBPs could help inform training efforts and the ways that these treatments may be better adapted for the military.

Educating medical professionals about suicide prevention among military veterans.

The aim of this paper was to discuss the results of a review of literature related to suicide in military veteran populations. Suicide in veteran populations has been increasing in recent years, and continues to be a medical and social problem across the globe. For medical health professionals, knowledge of the risk factors for suicide, careful assessment, and appropriate interventions are key to suicide prevention. The main aim of this review is to better understand the risk factors present in veteran suicide and find ways by which to educate medical professionals in suicide prevention. Key suicide risk factors found in veteran populations include posttraumatic stress disorder, major depressive disorder, physical injuries, substance use disorders, traumatic brain injury, combat-related guilt, access to firearms, and insufficient social support. Some psychosocial difficulties are unique to veteran populations, and medical professionals should be culturally sensitive to these factors. Psychosocial changes upon discharge from active duty, as well as stigma against mental health disorders and treatment, should also be considered and assessed. Given that general practitioners may be the first line of defense for these veterans, they should be educated in risk factors for veteran suicide and proper assessment techniques. Any suicide risk in a veteran population should be taken very seriously, and responded to appropriately.

Challenges, solutions, and best practices in telemental health service delivery across the pacific rim-a summary.

The Telemedicine and Advanced Technology Research Center, U.S. Army Medical Research and Materiel Command, in conjunction with the American Telemedicine Association's Annual Mid-Year Meeting, conducted a 1-day workshop on how maturing and emerging processes and applications in the field of telemental health (TMH) can be expanded to enhance access to behavioral health services in the Pacific Rim. The purpose of the workshop was to bring together experts in the field of TMH from the military, federal agencies, academia, and regional healthcare organizations serving populations in the Pacific Rim. The workshop reviewed current technologies and systems to better understand their current and potential applications to regional challenges, including the Department of Defense and other federal organizations. The meeting was attended by approximately 100 participants, representing military, government, academia, healthcare centers, and tribal organizations. It was organized into four sessions focusing on the following topic areas: (1) Remote Screening and Assessment; (2) Post-Deployment Adjustment Mental Health Treatment; (3) Suicide Prevention and Management; and (4) Delivery of Training, Education, and Mental Health Work Force Development. The meeting's goal was to discuss challenges, gaps, and collaborative opportunities in this area to enhance existing or create new opportunities for collaborations in the delivery of TMH services to the populations of the Pacific Rim. A set of recommendations for collaboration are presented.

Character strengths: a study of argentinean soldiers

The primary objective of this research was to study the differences in positive traits between military and civilian college students and between cadets in their first and final years at a military academy. Second, the research aimed to study the relations between positive traits and the academic and military performance of cadets in their first and final years, according to the classification of positive traits by Peterson and Seligman (2004). To accomplish these objectives, a sample of university students from a military educational institution and a sample of civilian university students were studied. The instruments used were a 24-item self-report measure of positive traits, a measure of social desirability, and objective scores of academic and military performance. The results generally showed that when age and career stage were held constant, the scores of the military students were higher than the scores of the civilian students across various strengths. Military students reported higher levels of the character strength of spirituality than did civilian students. The relationships between strengths and performance differed for students in their first and final years at the military academy. In particular, cadets with the higher levels of academic or military performance in their last year, i.e., the cadets best adapted to the academy, reported higher levels of the character strength of persistence when compared to low-performing cadets in the same year of study (AU)

Los objetivos de esta investigación fueron, por una parte, estudiar las diferencias en rasgos positivos entre estudiantes universitarios militares y civiles, y entre cadetes de primero y último año de una academia militar; y por otra, estudiar la relación entre los rasgos positivos y los rendimientos académicos y militares de cadetes de primero y de último año, siguiendo la clasificación de rasgos positivos de Peterson y Seligman (2004). Para ello se trabajó con una muestra de estudiantes universitarios de una institución militar educativa y con una muestra de estudiantes universitarios civiles. Se utilizó un autoinforme de rasgos positivos de 24 ítems, una medida de deseabilidad social y las calificaciones objetivas de los rendimientos académicos y militares. Los resultados generalmente mostraron que, equilibrados por edad y progreso en la carrera, las puntuaciones de los varones militares son más altas que las puntuaciones de los varones civiles en varias fortalezas. Se observó que los estudiantes militares muestran mayores niveles de la fortaleza espiritualidad que los estudiantes civiles. Son diferentes las relaciones entre las fortalezas y los rendimientos para primero y último año de cursada militar. Particularmente en el último curso, se observó que los cadetes de altos rendimientos académicos o militares, i. e., los cadetes con mejor adaptación a la academia, muestran mayores niveles de la fortaleza persistencia, en comparación con los cadetes de bajos rendimientos del mismo año de estudios (AU)

Importance of anonymity to encourage honest reporting in mental health screening after combat deployment.

CONTEXT: US soldiers are required to undergo screening for depression, posttraumatic stress disorder (PTSD), and other mental health problems on return from service in Iraq or Afghanistan as part of routine postdeployment health assessments. OBJECTIVE: To assess the influence of the anonymity of screening processes on willingness of soldiers to report mental health problems after combat deployment. DESIGN: Anonymous and nonanonymous surveys. SETTING: US military. PATIENTS: US infantry soldiers' reporting of mental health problems on the routine Post-Deployment Health Assessment was compared with their reporting on an anonymous survey administered simultaneously. MAIN OUTCOME MEASURES: The Primary Care PTSD Screen, the Patient Health Questionnaire-2 (modified), the suicidal ideation question from the Patient Health Questionnaire-9, and several other questions related to mental health were used on both surveys. Soldiers were also asked on the anonymous survey about perceptions of stigma and willingness to report honestly. RESULTS: Of 3502 US Army soldiers from one infantry brigade combat team undergoing the routine Post-Deployment Health Assessment in 2008, a total of 2500 were invited to complete the anonymous survey, and 1712 of these participated (response rate, 68.5%). Reporting of depression, PTSD, suicidal ideation, and interest in receiving care were 2-fold to 4-fold higher on the anonymous survey compared with the routine Post-Deployment Health Assessment. Overall, 20.3% of soldiers who screened positive for depression or PTSD reported that they were uncomfortable reporting their answers honestly on the routine postdeployment screening. CONCLUSIONS: Current postdeployment mental health screening tools are dependent on soldiers honestly reporting their symptoms. This study indicates that the Post-Deployment Health Assessment screening process misses most soldiers with significant mental health problems. Further efforts are required to reduce the stigma of reporting and improve willingness to receive care for mental health problems.

[Servicemen mental health monitoring in different stages of military service].

The effectiveness of psychoprophylactic work on each of military service basic stages and how to optimize it have been presented. The universal system of mental health monitoring in whole period of military service has been developed. A possibility of differentiated rapid assessment of mental status for effective monitoring of mental health has been analyzed. Some practical recommendations for the unit doctors in the principles of servicemen distribution by group of mental health level and taking the appropriate organizational decisions have been advised.

Psychological guidelines for a medical team debriefing after a stressful event.

Medical and rescue workers are at risk of developing mental syndromes including post-traumatic stress disorder after disasters and it is widely accepted that they should be offered a preventive intervention. The Israel Defense Force Medical Corps has developed psychological guidelines for the medical forces: a medical team debriefing after treating the injured as a preventive intervention for an event that may be experienced as stressful. The main purpose of the debriefing is to investigate the circumstances of the event, analyze the medical team's functioning, and draw the relevant conclusions and the manner of their implementation. The purpose of the guidelines is to enhance mental coping, possibly prevent stress reactions, and help in screening individuals in need of further professional intervention for stress reactions. These guidelines are suitable for similar interventions in other professional teams.

A retrospective evaluation of TeleMental Healthcare services for remote military populations.

The objective of this study was to compare specific treatment and outcome variables between mental health care via videoconferencing to care provided in person. The study was a retrospective record review of service members and their adult civilian family members seen at two remotely located military bases. One group was seen via video conferencing (telemental health care [TMHC]) while a second group was seen face-to-face care (FTFC) and served as a control group. Chi-square tests were used to test for significance associations between therapy format and secondary variables. The Global Assessment of Functioning was unexpectedly and significantly more improved for the TMHC group than the FTFC care group. Mean change in Global Assessment of Functioning for FTFC (8.4) was significantly less than mean change for TMHC (15.3). There were no significant differences between the groups in the number of laboratories or studies ordered, self-help recommendations made, selected mental status elements, or number of patients prescribed two or more psychotropic medications. The rate of full compliance with the medication plan and follow-up appointments was significantly better for TMHC. Providers using TMHC told more patients to return for follow-up appointments in 30 days or less. Improved compliance, the unique interpersonal processes of care via TMH, and slightly shorter times to next follow-up appointment were the chief contributors. Alterations in the process of communication may have implications in the business, political, and military sectors.

[Difficulties and errors of army medical expertise of neuropsychological health of military personnel called for the military service].

The article presents data concerning army medical expertise of neuropsychic disorders of military personnel and recruits. Pathomorphism of diseases stimulates the development not only new unknown features of diseases but triggers appearance so far unfamiliar new illnesses including those of young people. The results of analysis of mistakes of army medical expertise should be used in subsequent developing of the control system on neuropsychic state of military staff.

Issues in temperamental unsuitability re-examining concepts and current practice in the British Army.

Currently, in the UK military, and particularly in the Army, a significant number of personnel are regularly discharged on the grounds of being assessed as "Temperamentally Unsuitable (TU) for military duties", under Queen's Regulations (QRs): (Army) 9.414 and 9.434 (1). In the last two years (2001--2003), preliminary figures suggest that approximately 700 serving personnel were recommended for discharge under this category by only four psychiatrists in the south of England. The regulations governing TU have been in existence and essentially unchanged since their development long before the 1960s albeit subject to parliamentary quinquennial review. The Army General and Administrative Instructions (AGAI) (2) standards also remain unchanged over this period. This paper raises questions about the current validity and relevance of existing TU concepts and regulations with suggestions as to what is being proposed in the context of changing roles, technology and advances in the modern armed forces.

Psychological autopsies: the current Department of Defense effort to standardize training and quality assurance.

Psychological autopsies have been gathered by the US military for a long time, both for lessons learned after a known suicide and to investigate an equivocal death. The term "psychological autopsies" is now being restricted to define an investigation by mental health to help determine, in an equivocal death, if the manner of death is a homicide, suicide, an accident, or from natural causes. The Department of Defense has developed policy, and is now implementing training and peer review. A sample model curriculum, report format and quality assurance standards are included.

Psychiatric treatment and operational readiness: clinical guidelines for Air Force practice.

Clinical criteria for psychiatric illnesses that are career limiting to active duty Air Force personnel are defined in Air Force Instruction (AFI) 48-123. The terms used in the AFI are not sufficiently specific to the standards of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). The authors review AFI 48-123 for conditions commonly seen in Air Force mental health practice and offer clinical interpretation of this AFI to bring it into line with DSM-IV. As a result of this synthesis, decisions regarding which mental health conditions warrant medical evaluation board disposition are clearer and more uniform. Clinicians and administrators are encouraged to refer to this paper for assistance in making decisions on mental health patients.

[Reduced but better health care for armed forces]. / Försvarsmaktens sjukvård bantas, men blir bättre.

The Swedish Armed Forces are presently undergoing the most extensive reorganization and downscaling in their history. In a new set of objectives for the Swedish Armed Forces Medical Service laid down by the Surgeon General, the aim is to provide combat casualty care with a quality on par with that of the civilian, peace-time health care system. This will be achieved by establishing advanced trauma care by specialist physicians and nurses closer to the point of injury, using armoured medical evacuation vehicles, and by introducing new treatment modalities such as intraosseous infusion using hyperoncotic solutions.

Confidentiality and the psychological treatment of U.S. Army aircrew members.

The present article addresses the issue of confidentiality in U.S. Army psychological services and the special considerations affecting the confidentiality afforded to Army aviation personnel receiving such services. The author reviews Army regulations and American Psychological Association ethical standards relevant to the issue of confidentiality for aircrew members. Recommendations are offered for mental health professionals who provide services to Army aviation personnel, and a hypothetical clinical case is presented to illustrate the concepts discussed.